Adolescent dual-product users: Acquisition and situational use of cigarettes and cigars

Likelihood of Adolescents Trying Conventional or Electronic Cigarettes Varies with Their Use and Perception of Harm and Addictiveness of Other Tobacco Products, Including Cigars

OBJECTIVES

Developing a comprehensive understanding of tobacco product use among adolescents requires information about the use of conventional cigarettes; electronic cigarettes (e-cigarettes); other tobacco products such as cigars, little cigars, and cigarillos (CCLCs); and smokeless tobacco. In particular, the use of products other than cigarettes may have important implications for additional smoking-related behaviors and the health of students and adolescents.

METHODS

The National Youth Tobacco Surveys for 2017, 2018, and 2019 were aggregated to analyze the characteristics of middle school and high school students who had used tobacco products, such as CCLCs. Information collected included age, sex, race, and perceptions about harm and addiction related to tobacco products. Multiple logistic regression models were used to evaluate the associations between having used conventional/e-cigarettes and having used CCLCs, while adjusting for the perceived harm of conventional/e-cigarettes, sex, age, and other risk factors.

RESULTS

These combined surveys included 50,172 responses; 6836 respondents (13.6%) had tried CCLCs. Male students used these products more frequently than female students. Students in older age groups (15, 16, 17, and 18 and older,) had used these products more frequently than younger students. The odds for students in this CCLCs subgroup trying conventional cigarettes decreased in those who thought that conventional cigarettes could cause "some harm" or "a lot of harm." The odds for having tried e-cigarettes in the CCLCs subgroup decreased in those who thought that e-cigarettes could cause harm and increased in those who thought that conventional cigarettes could cause "little harm" or "a lot of harm."

CONCLUSIONS

More than 10% of middle school and high school students have used CCLCs. The majority of students in this subgroup also have used either conventional cigarettes or e-cigarettes. Understanding possible harm with cigarette use is significantly associated with the reduced use of conventional and e-cigarettes, and using CCLCs independently contributes to the increased risk of using conventional and e-cigarettes. The frequent use of several tobacco products makes surveys in this age group more complicated and indicates that educational efforts and public policies regarding tobacco need to include all tobacco products.

Cigarillo and multiple tobacco product use and nicotine dependence in adolescents and young adults

INTRODUCTION

Multiple tobacco product (MTP) use is a growing public health concern, particularly among adolescents and young adults. This study identifies subgroups of MTP use among cigarillo users and examines associations with nicotine dependence (ND).

METHODS

1089 youth (ages 14-28) who currently smoke cigarillos completed a web-based survey regarding their current use of cigarillos, little cigars, traditional cigars, cigarettes, e-cigarettes, and waterpipe/hookah. Latent class analysis (LCA) was used to identify patterns of product use by type and amount. The LCA also assessed the relationship between the latent classes and a 38-item measure of ND, controlling for relevant demographics.

RESULTS

Most participants (88.2%) reported using two or more tobacco products in the past 30 days. The best-fitting LCA solution revealed 7 classes: (1) Mixed-Light tipped cigarillo and light cigarette users, 28.9%; (2) Light tipped cigarillo users, 15.8%; (3) Light untipped cigarillo users, 14.3%; (4) Heavy tipped cigarillo users, 13.4%; (5) E-cigarette and waterpipe users, 11.9%; (6) Heavy users of tipped and untipped cigarillos and light users of cigarettes, 9.8%; and (7) Dabblers who primarily used traditional cigars, but were also likely to use a variety of other products, 6.1%. Classes comprised of those using multiple products-particularly those that included cigarettes-had significantly higher levels of ND than other classes (Tukey's HSD P < .05).

CONCLUSIONS

Distinct patterns of MTP use are evident among young cigarillo smokers. Smoking multiple products, particularly smoking cigarillos in combination with cigarettes, is associated with higher ND compared to other product use patterns.